Anti-Depressants: Real or Bogus?

Huge Shocking Study by Psychiatrists (Adapted from ScienceNews July 20 2022)

In this huge comprehensive review of a large body of scientific evidence, it is being shown that “low levels of serotonin” do NOT cause depression.

This new set of numerous studies is so large it is called an “umbrella” review. It’s an overview of existing meta-analyses and systematic reviews and was published in Molecular Psychiatry.

This large look into science suggests that depression is not likely caused by a “chemical imbalance”. It questions what antidepressants actually do. And if one should even use anti-depressants at all!

Most antidepressants are “selective serotonin reuptake inhibitors” (SSRIs), which were originally said to work by correcting abnormally “low” serotonin levels.

We have been told that much of depression is due to low serotonin. (BTW in functional medicine we recognize that much of serotonin is “made” in the gut, and the gut/brain axis is highly important in how we “view our world”).

Lead author Professor Joanna Moncrieff, a Professor of Psychiatry at University College of London and a consultant psychiatrist at North East London NHS Foundation Trust (NELFT), said: "It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is NO convincing evidence that depression is caused by “serotonin abnormalities”, particularly by lower levels or reduced activity of serotonin.

Wow.

"The popularity of the 'chemical imbalance' theory of depression has coincided with a huge increase in the use of antidepressants. Meds. Meds. Meds.

Although, some of my patients swear by these meds.

I have come to realize this true-ism: “never say never”.

Prescriptions for antidepressants have risen dramatically since the 1990s, with one in six adults in England and 2% of teenagers now being prescribed an antidepressant in any given year (remember this study comes out of England).

Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence.

Wow.

This umbrella review aimed to capture all relevant studies that have been published in the most important fields of research on serotonin and depression.

The studies included in the review involved “tens of thousands” of participants.

Research that compared levels of serotonin and its breakdown products in the blood or brain fluids did NOT find a difference between people diagnosed with depression and healthy control (comparison) participants.

Research on serotonin receptors and the serotonin transporter, the protein targeted by most antidepressants, found weak and inconsistent evidence suggestive of higher levels of serotonin activity in people with depression.

The authors also looked at studies where serotonin levels were artificially lowered in hundreds of people by depriving their diets of the amino acid required to make serotonin. These studies have been cited as demonstrating that a serotonin deficiency is linked to depression.

A meta-analysis conducted in 2007 and a sample of recent studies found that “lowering” serotonin in this way did “not” produce depression in hundreds of healthy volunteers, however.

There was very weak evidence in a small subgroup of people with a family history of depression, but this only involved 75 participants, and more recent evidence was inconclusive.

Very large studies involving tens of thousands of patients looked at gene variation, including the gene for the serotonin transporter.

They found no difference in these genes between people with depression and healthy controls.

What they did find was that depression was most linked to “stressful life event”.

These studies looked at the effects of stressful life events and found that these exerted extremely strong effects on people's risk of becoming depressed.

The more stressful life events a person had experienced, the more likely they were to be depressed.

Boy, the last few years have put much of the planet into PTSD… it seems.

A famous early study found a relationship between stressful events, the type of serotonin transporter gene a person had and the chance of depression. But larger, more comprehensive studies suggest this was a false finding.

Doesn’t this all show how risky it is to say that science can prove something?

All the above findings led the authors to conclude that there is "NO support for the hypothesis that depression is caused by “lowered serotonin” activity or concentrations."

The researchers say their findings are important as studies show that as many as 85-90% of the public believes that depression is caused by low serotonin or a chemical imbalance.

And so do their docs prescribing the serotonin boosting meds.

 A growing number of scientists and professional bodies are recognizing the chemical imbalance framing as an over-simplification.

There is also evidence that believing that low mood is caused by a chemical imbalance leads people to have a pessimistic outlook on the likelihood of recovery, and the possibility of managing moods without medical help.

Present medical practices often hand out scripts like M & Ms and bandaids, rather than asking about diet, lifestyle and coping skills.

The authors also found evidence from a large meta-analysis that people who used antidepressants had lower levels of serotonin in their blood!

They concluded that some evidence was consistent with the possibility that long-term antidepressant actually reduces serotonin concentrations! Oy.

I think a lot of depression is due to gut health and lifestyle choices, but this is very fascinating. Shouldn’t psychologists and psychiatrists look at what people eat, how much they move, their intimacy, etc.? Anyhow…

The researchers say this may imply that the increase in serotonin that some antidepressants produce in the short term could lead to compensatory changes in the brain that produce the opposite effect in the long term.

Professor Moncrieff said: "Our view is that patients should NOT be told that depression is caused by LOW serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities. We do not understand what antidepressants are doing to the brain exactly and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not."

It also doesn’t encourage people to look at how they live, eat, move, sleep, and interact with others, as major influencers on the lens through which they view their lives.

Co-author Dr Mark Horowitz, a training psychiatrist and Clinical Research Fellow in Psychiatry at UCL and NELFT, said: "I had been taught that depression was caused by low serotonin in my psychiatry training and had even taught this to students in my own lectures. Being involved in this research was eye-opening and feels like everything I thought I knew has been flipped upside down.

"One interesting aspect in the studies we examined was how strong an effect “adverse life events” played in depression, suggesting low mood is a response to people's lives and cannot be boiled down to a simple chemical equation."

I think this is why life coaching has become such a successful phenomena btw.

Professor Moncrieff added: "Thousands of people suffer from “side effects” of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise.

“We believe this situation has been driven partly by the “false” belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is NOT grounded in science."

The researchers caution that anyone considering withdrawing from antidepressants should seek the advice of a health professional, given the risk of adverse effects following withdrawal.

Professor Moncrieff and Dr Horowitz are conducting ongoing research into how best to gradually stop taking antidepressants.

It seems that we need to have “tools” to deal with stressful events. I think these tools should start to be taught in the schools at the first grade and throughout all levels of studies.

They are as important, if not more, than math and history. They are the way we move through life. And deal life’s stressful events.

I have put together a series of small, uncomplicated, illustrated, interactive books for kids… but am looking for someone to help me get them into schools.

If you have any ideas let me know.

How to listen, how to feel inside your “body suit”, how to reach a kind middle-ground within conflict, how to breathe, how to eat, how to deal with anger and disappointment, these are all critical tools to keep sane amidst the insanity and chaos that life inevitably serves up to us all.

Gently yours,

Dr. B.

Reference:

The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 2022; DOI: 10.1038/s41380-022-01661-0